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How do I know if there is a crisis?

What if my relative or friend is in crisis and wants help?

What if my relative or friend is in crisis and does not want help?

What if the crisis situation becomes an emergency?

Know your rights.

How do I know if there is a crisis?

A series of questions on this Web page, "Crisis/emergency procedures," helps you identify a crisis and tells you where to go for immediate help. This Web page is part of the Mental Health Association in California's (MHAC) Web series, Reaching for the Light.

What if my friend or relative is in crisis and wants help?

Call your county's 24-Hour Multilingual Crisis Intervention and Assessment number or call your local hospital's psychiatric emergency service. Be prepared to bring the client to a psychiatric facility for an evaluation. Explain the crisis to clinical staff. They will tell you what to do next. Ask the staff if the county can bring in clients trained in crisis support services. Also ask if the county has voluntary drop-in crisis assistance, a respite house, or another facility designed to provide safe shelter and treatment for clients in crisis. Find out if the client has written a psychiatric advance directive and read it. A psychiatric advance directive is a legal document some clients prepare to express their wishes in the event of a future crisis or possible involuntary commitment. Talk with people you know who have provided support to clients in crisis.

What if my friend or relative is in crisis and does not want help?

People under great emotional stress refuse help for many reasons. A client may have had a bad experience with the mental health system, or may be fearful of treatment. The very thought of a psychiatric hospital setting can make some people in crisis feel like they will be worse off with help than without. In the event your loved one is in crisis and you are worried about their welfare, call your county's 24-Hour Multilingual Crisis Intervention and Assessment number or your local hospital's psychiatric emergency service and explain the situation. Listen to their advice, and follow the same steps suggested above (What if my friend or relative is in crisis and wants help?).

What if the crisis situation becomes an emergency?

Involuntary evaluation and treatment is usually traumatic for mental health clients. Most clients, caregivers and family members agree that even in a crisis situation, every effort should be made to meet clients at their location and provide acceptable options and assistance. Sometimes, however, involuntary treatment is the only option available for protecting a person's and others' safety, and, it is hoped, getting the person the help he or she needs. Under California law, before being subject to involuntary treatment an adult must be a danger to others, suicidal or gravely disabled (that is, unable to provide for clothing, food or shelter).

If the client meets one of these criteria, he or she can be taken to a designated psychiatric facility and held involuntarily for up to 72 hours for evaluation and treatment. This is called a 5150, after the number of the section in the California Welfare Law. The person can be certified for up to 14 days of additional treatment, a "5250," if the staff at the psychiatric facility believe the client meets criteria for a continued hold.

In the event a loved one is involuntarily committed, there are a number of things you should or can do.

If the police are called, support the client by asking the officers to keep their approach as nonconfrontational and respectful as possible. Remember, when clients return to their homes and communities, they may have to face questioning looks from neighbors and friends.
Ask the client what will help them feel calm, and provide it if possible.
Ask the client if he or she wants you to come along to the facility where the evaluation and possible detainment will happen. Then ask the police for permission to go with the client.
Ask the client what personal items might be comforting, from a photograph to a favorite piece of clothing, and bring these items along.
If the client has a group of friends that provide personal support, let them know that the person has been involuntarily detained and will need their help upon discharge.
Find out if the client has written a psychiatric advance directive and follow its directions.

For more information on client and family member rights and involuntary treatment and to learn what you can do to help your friend or relative through this difficult experience, contact your county Patient's Rights advocate.

If it is an emergency and the police are called:

Be prepared to describe your friend's or relative's behavior. Try to include information about medications he/she might be taking.
The police may arrange transport for your friend or relative to have a psychiatric evaluation and screening. As described above, this is called a 5150. The client can be held up to 72 hours.
Be clear in your description, and don't exaggerate.
Your family member or friend may be admitted to a psychiatric emergency facility, but may or may not be kept in a hospital. If hospitalized, he/she can be released without notification to the family.
By law, unless your relative or friend gives consent, the psychiatric facility cannot tell you if he/she is a patient there. This can be hard for family members, especially if they know their relative is in the facility. Experts recommend that family members try to take care of themselves during this difficult period, and seek support.

Know Your Rights

People with mental illness have the same inalienable rights that all citizens have. Here are some resources for guidance for you or your loved one in maintaining control over the treatment and recovery.

Read the Patient Rights Advocacy Manual produced by the California Association of Mental Health Patient's Rights Advocates. It covers 20 topics, ranging from advocacy skills to seclusion and use of restraints to patient's rights and confidentiality to treatment of minors.
If you have a complaint with services in the public or private sector, contact a Patient's Rights advocate through the California Office of Patient Rights, which contracts with the California Department of Mental Health to ensure adherence to mental health laws and the rights of patients. The office has direct advocacy services on-site at four state hospitals, and responds to patients' complaints.
Some clients prepare a legal document, called a psychiatric advance directive, to express their wishes in the event of a future crisis or possible involuntary commitment. The Bazelon Center for Mental Health Law offers a set of templates for preparing a psychiatric advance directive.

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